~**~ Omentum Transposition ~**~

EDITOR'S NOTE
Many years ago, Harry Goldsmith pioneered the use of omentum in the treatment of central nervous system diseases. His work has not been widely received in several countries; perhaps this is related to its pioneering aspect, to the fact that Dr. Goldsmith is a general surgeon rather than a neurologist or neurosurgeon, and to the general lack of credibility of some of the results produced, particularly in people with long-standing cerebral infarction and spinal cord injury. Yet, review of the publications by Dr. Goldsmith and his colleagues over the years find that there have been many intriguing results reported, which appear to have scientific merit. Dr. Goldsmith has stressed that randomized studies are necessary to compare the value of this approach with traditional methods of treatment.		As scientists, we must explore this and other "unusual" concepts with objectivity. It is for this reason that *Surgical Neurology* is publishing the results of the First International Congress of Omentum in CNS held in China in May, 1995. Neurosurgeons should be aware of work in related fields which impacts their specialty. It is only by maintaining an open mind that neurosurgeons can prevent encroachment on their specialty by others who are more willing to explore unique ideas and options, rather than discarding them out of hand. This review is presented for your information; the final judgments are yours. James I. Ausman, M.D., Ph.D. Editor, Surgical Neurology

THE FIRST INTERNATIONAL CONGRESS
OF OMENTUM IN CNS

The first international congress on the use of omentum to the brain and spinal cord was held May 7-11, 1995 in Xauhou City, China. There were 150 submitted abstracts, of which 62 were chosen for presentation, involving all aspects of omental transposition (OT) to the CNS: i.e., basic research, clinical applications, anesthesia, nursing, and so on. There were 120 doctors in attendance with simultaneous English and Chinese translation for all papers. Some representative presentations given at the Congress are listed below.

BASIC RESEARCH
Meng Qing et al presented a paper, "Experimental Investigation on Omental Transposition in Spinal Cord Ischemic Injury - Application of Magnetic Stimulation (MEP) Monitoring." The thrust of this paper

was that motor evoked potentials were more accurate in substantiating clinical improvement following OT to an injured spinal cord in dogs compared to SEP (somato-sensory) determinations. This experimental data was further substantiated in patients who had MEP studies following OT for chronic spinal cord injuries.

T.G. Yarrow, et al, delivered a paper, "Preliminary Results of the Application of Omentum to Severely Injured Canine Spinal Cord." Concussive injury to the canine thoracolumbar spinal cord occurs commonly. Dogs that lose total pain perception in their hind legs (a complete injury) rarely recover walking ability. This veterinary group from London performed OT in nine such dogs and four recovered the ability to walk by 9 weeks after surgery as did another dog within 1 year.

Qu Jian et al presented "HRP Study on Therapeutic Effect of Transplantation of Omental Graft on Experimental Spinal Cord Trauma in Rats." These investigators concluded that OT to an injured spinal cord in rats "enhanced the restoration of the interrupted axial transport along the rubro-spinal tract following spinal cord injury" which they felt "morphologically confirmed the therapeutic value of omental transplantation for traumatic paraplegia."

Several papers were presented which dealt with neurochemicals known to be present in the omentum and the effect of these biological agents on an injured spinal cord. Tang Yageng at al reported "Changes of TXB2 and 6-K-PGFI Before and After Omental Transposition to Injured Spinal Cord in Rabbits." These investigations concluded that the omentum "inhibited TXB2 production and improved the TXB2/6-K-PGF(1) ratio and hence, protected the spinal cord from secondary injuries."

Xin Yuan Li et al presented another basic science paper dealing with angiogenic agents within the omentum entitled "Angioigenisis of PGE1 and PGE2 in the Transposition of the Pedicled Omentum." It was postulated that the lipid factors within the omentum were directly responsible for the angiogenic activity.

L. Ferguson et al from Chicago reported on "Omental Transplantation Graft for Arachnoiditis and Radiation Necrosis." This group presented six patients with lumbosacral adhesive arachnoiditis of long standing. Three of the patients showed excellent clinical results after OT surgery, two good results and one had fair improvement. The reason for the clinical improvement was felt to be due to a biological factor in the omentum that prevents fibrosis. In the past when scar tissue was removed from the spinal cord in a patient with arachnoiditis, the scar would reform. However, when the omentum is laid on the spinal cord after the scar tissue has been surgically removed, the omentum

prevents or limits the recurrence of postoperative fibrosis at the site of cord injury. (This observation has been previously reported in 1985 and 1989.) The concept that there were factors in the omentum beneficial to the injured spinal cord went along with another presentation. "Transplantation of Greater Omentum to Spinal Cord in 25 Cases of Paraplegia" by Chi Fengling et al. This study showed 76% of the patients showed significant improvement in motor function 72% had sensory improvement and 15 of the 25 had improvement in voiding

and defecation. The clinicians involved with these patients felt that their neurological improvements were due to "special biochemicals in the omentum which can stimulate the function of the injured spinal cord and regulate the microcirculatory disorder so that normal bioelectrical activity and metabolism of nerve cells can be restored." These authors, like Ferguson, felt that, "surgery frees the spinal cord from adhesions and bindings which restrain circulation and subsequently allow the omentum to fully play its role."